One of the first questions we get asked is whether or not the installation of a walk-in tub will be covered by Medicare and Medicaid.
The short answer is, no…
BUT…there are some exceptions. And it’s even more important to keep in mind that Medicare is not your only option.
Why Won’t Medicare Cover a Walk-in Tub?
Although it might be deemed a medical necessity for some people, especially seniors and others with limited mobility problems, original Medicare does not categorize walk-in tubs as durable medical equipment (DME) most of the time.
Another reason is the fact that it involves a physical change to the home, rather than an addition.
Having said that, there are some situations that might still qualify for some coverage, providing it is an absolute medical necessity.
How To Qualify for a Medicare Walk-in Tub
If you are eligible for Medicaid, and you have a prescription for your doctor stating that it is an absolute necessity, your state might offer programs that have financial assistance for a walk-in tub. And while it is not a guarantee, there is a slim chance of some financial support from Medicare Part B.
Medicare Plan B
Part B of Medicare provides coverage for necessary and preventive services.
This includes a second opinion before surgery, ambulance services, clinical research, mental health, and also DMEs, provided you have the necessary documentation from your physician.
Only your doctor will be able to highlight the medical need for a walk-in tub, which can make you eligible to receive reimbursement for a portion of the price.
Patients rarely receive coverage for it, however, and the cost of installations is not covered either. Also important to remember is the fact that reimbursements only take place after the initial order of the walk-in tub has been made.
The paid invoice can then be submitted along with your prescription and other supporting documents from your physician including dates and signatures, and a clear diagnosis as to why the walk-in tub should be considered.
What Are My Other Options?
If exploring Medicare Part B and you have failed to completely satisfy in your applications that the tub is a medical necessity, you could consider Part C.
Medicare Advantage Plan – Part C
Medicare currently has numerous options for their Advantage Plan, including Parts A, B, C, D, F, G, K, L, M, and N. The part that should be of particular interest and offers the best chance of receiving some form of reimbursement for the installation of a necessary walk-in tub is Part C. This part stipulates that private companies approved by Medicare may offer to cover the cost of a walk-in tub.
Medicaid Supplemental Healthcare Benefits
As of 2019, Medicaid also offers new supplemental healthcare benefits, which are very similar to the Medicare Advantage Plan. Instead of being a single Federal program, there are many State programs that are governed by a multitude of different rules that include Medicaid HCBS waivers. You should examine the benefits of your state’s Medicaid waivers to establish your options for the installation of a walk-in tub.
VA Benefits and Grants
Although it is impossible to say with surety that the VA will assist with paying for a walk-in tub, or any sort of home modification to your home for that matter, they do have a number of programs that might be able to assist and worth checking out. These include:
You might be able to claim a tax deduction on your walk-in tub, but this will depend on a few things and has to be for treatment or prevention of disease and not merely beneficial for general health.
However, should the tub be purchased for medical safety reasons, it can be considered a medical expense and homeowners could make a claim under the Dependent Care Tax Credit.
So, although Medicare does not unequivocally cover for the installation of a walk-in tub, there are several acceptions and several options to explore that could help pay for the installation of a walk-in tub.
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Unfortunately for seniors, Medicare does not typically pay for a walk-in tub. The program covers products considered to be “durable medical equipment,” i.e., durable equipment or devices that are medically required by a doctor to be used in the home and not typically useful to someone who isn’t sick or disabled. Because walk-in tubs are not classified in this way, Medicare usually will not cover them.
The upside is there are alternative finance options to purchase a walk-in tub. Learn if you may qualify for financial assistance through one of the programs, plans or grants listed below.
Other Financial Assistance Options
MEDICARE FOR WALK-IN TUBS
In rare situations, original Medicare may make an exception and cover the cost of a walk-in tub. However, you’d receive a reimbursement instead of an upfront payment. This means there is no guarantee that original Medicare would offer financial assistance until after you paid out of pocket and submitted a claim.
To submit a claim, you have to prove the walk-in tub was an absolute medical necessity through a written medical diagnosis made by a doctor, which would include the reasons for why it’s needed and any essential features specific to a brand.
If you choose to go this route, you should be prepared to pay the full cost of the walk-in tub and additional installation costs, or seek other financial assistance.
MEDICARE ADVANTAGE (MA) PLANS
Getting original Medicare to pay for a walk-in tub is often a hassle and rarely delivers the outcome you want. Your best chance of receiving financial assistance through Medicare is with Medicare Advantage (MA) plans, or Plan C, which enables private insurance companies to contract with Medicare. Due to an expansion of health-related supplemental benefits in 2019, some MA plans will cover the cost of a walk-in tub.
Not all MA plans are alike, so it’s important you talk to your plan’s representative about the types of benefits they offer. To learn more about your specific coverage, contact Medicare.
MEDICAID FOR WALK-IN TUBS
Compared to Medicare Advantage plans, Medicaid is more likely to pay for a walk-in tub. Because each state offers several different Medicaid programs, there is no universal rule governing its policy on home modifications. Contact your representative to confirm if your plan covers the cost of a walk-in tub.
HOME AND COMMUNITY-BASED SERVICES (HCBS)
You should also consider Medicaid’s Home and Community-Based Services (HCBS) Waiver program. This program enables those with significant physical and cognitive limitations to receive services in their own home or community. Depending on which state you live, an HCBS waiver may pay for specialized medical equipment and environmental accessibility modifications, which can include the purchase and installation of a walk in tub.
To determine if your state’s Medicaid waivers will pay for a walk in tub, contact the Center for Medicaid and CHIP Services (CMCS).
Veterans Benefits for Walk-In Tubs
The Department of Veterans’ Affairs offers several programs that provide financial assistance for the purchase and installation of a walk in tub. Read on to learn if one of these options is right for you.
HOME MODIFICATION GRANTS
Disabled veterans who are eligible may apply for grants to install home modifications that support disabilities related to their military service or resulting from aging. The two grants include:
- Specially Adapted Housing (SAH) Grant
- Special Home Adaptation (SHA) Grant
VETERANS DIRECTED HOME AND COMMUNITY BASED SERVICES (VD-HCBS)
This program is modeled after Medicaid’s HCBS Waiver program. Participants receive a set budget to spend at their discretion on care services and supplies they elect as a medical necessity. As such, veterans may use a portion of the funds to purchase and install a walk-in tub or shower.
VA AID AND ATTENDANCE, HOUSEBOUND AND OTHER PENSIONS
These pensions offer greater freedom to decide how the allowance is spent. With the only stipulation that it be used for the care of the beneficiary, a walk-in tub is an appropriate expense. The cost of a walk-in tub can also be considered an unreimbursed medical expense, which means it can be deducted from a veteran’s income. In turn, the veteran’s pension benefit will increase in the amount of the deduction, essentially covering the cost of the tub.
To learn more about veterans benefits, please contact your regional VA office or check out our blog.
Grants for Walk-In Tubs
The “Rural Repair and Rehabilitation Loans and Grants for Seniors” is a housing repair program offered by the US Department of Agriculture. This program assists seniors living on a low income in rural areas by offering grants that can cover home repairs, improvements or modifications to their home. It also applies to home modifications and accessibility features that eliminate health and safety hazards, including the cost of a walk-in tub.
You can begin the application process by contacting your local USDA service center.
Financing Plans for Walk-In Tubs
Accessible bathing is an important investment to help you continue living in the home you love. At KOHLER, we are committed to offering walk-in tubs that blend the best in safety, comfort and affordability. We offer financing plans for all walk‑in baths as well as monthly offers to make the bath even more affordable.